Post COVID-19 acute invasive fungal rhinosinusitis caused by Scedosporium apiospermum: a covert pathogen

Immune dysregulation caused by COVID-19 and the presence of risk factors such as diabetes, steroid therapy and immune-modulatory drugs significantly increase the risk of secondary invasive fungal infections. Scedosporium apiospermum is an emerging pathogen and is rarely reported as a cause of fungal rhinosinusitis. This was a previously unreported case of post COVID-19 acute invasive fungal rhinosinusitis caused by S. apiospermum with rare complications of cranial nerve palsies and ruptured mycotic intracranial aneurysm.

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Invasive fungal rhinosinusitis associated with COVID-19: An observational study

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.049 ◽

2021 ◽

Vol 7 (4) ◽

pp. 237-241

Author(s):

Bhagyashri Jadhav ◽

Neeta Patwardhan

Keyword(s):

Observational Study ◽

Viral Infections ◽

Respiratory Infections ◽

Fungal Infections ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

History Of ◽

Lost To Follow Up ◽

Invasive Fungal Rhinosinusitis

Respiratory Viral infections predispose patients to various coinfections and this may lead to enhanced disease severity and mortality. Despite the proven importance of co-infections, these are understudied during the large outbreaks of respiratory infections. Occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained increasing attention recently. This study aims to assess Clinical & Microbiological profile of patients with invasive sinusitis in setting of COVID-19 disease at our institute Study Design: A retrospective observational study. Study included patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) suffering from or having a history of coronavirus disease infection over the period of three months.(April 21 – June 21). The patients’ presentation details, imaging findings, co-morbidities, management details, and follow-up information were obtained, recorded and analysed. A total of 32 patients with AIFR with a mean age of 54.46±13.13 years old were included. Most common associated disease was diabetes mellitus (62.5%). Mycological analysis revealed most common fungi isolated from these patients were Mucor species.(56.25%) followed by Aspergillus species(15.62%) while coinfection with both of these species was seen in 5 patients.(15.62%) Candida species was isolated from samples of 4 patients (12.5%). Radiological studies of nose and paranasal sinuses showed that ethmoid (62.5%) and maxillary (46.87%) sinuses being the most commonly affected sinuses followed by Frontal (31.25%) and sphenoid (21.87%) sinuses. Peri-orbital invasion was seen in 5 (15.62%) cases whereas intracranial involvement was seen in 1 patient.(3.12%) In 8 (25%) patients only medical line of treatment was sufficient whereas 20 (62.5%) patients required surgical debridement during the treatment. 4 patients were lost to follow up. Overall survival was 90.62% (29/32) at the conclusion of the study. We are still learning the new and long-term complications of COVID- 19.The puzzle still remains unsolved about the cause and increased prevalence of invasive fungal infections in post-covid-19 population. High clinical suspicion and early and accurate diagnosis of AIFR in COVID-19 patients are essential for better prognosis.

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Invasive fungal rhinosinusitis

Romanian Journal of Rhinology ◽

10.2478/rjr-2019-0001 ◽

2019 ◽

Vol 9 (33) ◽

pp. 13-19

Author(s):

Lucia Gariuc ◽

Alexandru Sandul ◽

Lupoi Daniel

Keyword(s):

Risk Factors ◽

Early Treatment ◽

Imaging Techniques ◽

Diagnostic Information ◽

Immunocompromised Patients ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive ◽

Systemic Antifungal Therapy

Abstract Invasive fungal rhinosinusitides are a group of disorders with three subtypes (acute invasive fungal rhinosinusitis, chronic invasive fungal rhinosinusitis and granulomatous invasive fungal rhinosinusitis), requiring urgent diagnosis and early treatment due to the reserved vital and functional prognosis. This disorder occurs in immunocompromised patients, but it can also occur in immunocompetent people. Aspergillus and Mucormicosis species are the most common microorganisms found in invasive fungal rhinosinusites. The otorhinolaryngologic clinical examination and imaging techniques provide important diagnostic information in patients with risk factors for invasive fungal rhinosinusitis, including intracranial or orbital extension identification. The treatment of invasive fungal rhinosinusites (acute or chronic) consists of reversing immunosuppression, appropriate systemic antifungal therapy and aggressive and prompt surgical debridement of the affected tissues.

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The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.103080 ◽

2021 ◽

pp. 103080

Author(s):

Wael F. Ismaiel ◽

Mohamed H. Abdelazim ◽

Ibrahim Eldsoky ◽

Ahmed A. Ibrahim ◽

Mahmoud E. Alsobky ◽

...

Keyword(s):

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

The Impact ◽

Invasive Fungal Rhinosinusitis

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Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis

Neuroradiology ◽

10.1007/s00234-018-2034-0 ◽

2018 ◽

Vol 60 (7) ◽

pp. 715-723 ◽

Cited By ~ 8

Author(s):

Ye Ra Choi ◽

Ji-hoon Kim ◽

Hye Sook Min ◽

Jae-Kyung Won ◽

Hyun Jik Kim ◽

...

Keyword(s):

Mr Imaging ◽

Imaging Features ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis

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Fungal diseases of the ear, nose, and throat

10.1093/med/9780198755388.003.0024 ◽

2017 ◽

Author(s):

Arunaloke Chakrabarti

Keyword(s):

Invasive Disease ◽

Sinus Disease ◽

Laryngeal Diseases ◽

Non Invasive ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Invasive Infections ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive ◽

Nose And Throat

Fungal infection of the ear (otomycosis), nose (fungal rhinosinusitis), and throat (oropharyngeal candidiasis) are common diseases. Fungal laryngeal diseases and invasive otomycosis & acute fungal rhinosinusitis are much less common and occur in immunosuppressed hosts, including those with diabetes. Aspergillus and Candida spp. are the commonest causes of otomycosis, whilst Aspergillus spp. predominate in sinus disease, with members of the Mucorales also causing serious invasive infections. Management of the non-invasive conditions can be difficult, and otomycosis and rhinosinusitis often become chronic. Invasive disease usually requires surgical intervention along with appropriate antifungal therapy. Acute invasive fungal rhinosinusitis has a mortality of approximately 50%.

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Retrospective Analysis of Patients With Acute Invasive Fungal Rhinosinusitis in a Single Tertiary Academic Medical Center: A 10-Year Experience

American Journal of Rhinology and Allergy ◽

10.1177/1945892419896233 ◽

2019 ◽

Vol 34 (3) ◽

pp. 324-330

Author(s):

Gennadiy Vengerovich ◽

Kristen A. Echanique ◽

Ki Wan Park ◽

Christine Wells ◽

Jeffrey D. Suh ◽

...

Keyword(s):

Medical Management ◽

Medical Center ◽

Academic Medical Center ◽

Sinus Surgery ◽

Open Approach ◽

Presenting Symptoms ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Academic Medical ◽

Invasive Fungal Rhinosinusitis

Background Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive, potentially fatal disease that can spread rapidly to the orbit and intracranial structures causing significant mortality and morbidity. Objective In this study, we present a 10-year experience from a tertiary academic medical center of patients presenting with AIFRS. Data on presentation, mortality rate, comorbidities, surgical, and medical management were analyzed. Methods A retrospective chart review was performed in a tertiary academic medical center of patients with AIFRS from January 2009 through February 2019. Data collected included demographics, presenting symptoms, comorbidities, immunosuppression status, endoscopic and imaging findings, orbital and intracranial complications, surgical and medical management, as well as outcomes and mortality. Results A total of 34 patients were identified. In our series, mortality was noted to be 61.8%, excluding patients who were lost to follow-up. The most common presenting symptoms included facial pain, ophthalmologic complaints, headaches, and proptosis. Only 4 of the 34 patients did not undergo surgical intervention, as they were not deemed surgical candidates; they all succumbed to their disease. Twenty-six of the 30 surgical patients (86.7%) underwent endoscopic sinus surgery, 8 underwent an open approach (26.7%), while 7 patients underwent orbital exenteration (23.3%). All patients had surgical pathology consistent with AIFRS. Fungal species isolated from culture included Aspergillus, Mucor/ Rhizopus, Candida, Cunninghamella Scedosporium boydii, Paecilomyces, and Scopulariopsis. Medical therapies included intravenous amphotericin B, caspofungin, posaconazole, voriconazole, isavuconazole, and micafungin. Conclusion AIFRS was associated with 61.8% mortality in our series of 34 patients over the past 10 years. Early diagnosis, as well as rapid and aggressive surgical and medical management, is necessary for optimal outcomes in this devastating disease.

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